Final Flashcards
1
Q
CN I
A
Olfactory (smell)
2
Q
CN II
A
Optic (vision)
3
Q
CN III
A
Oculomotor (EOM, raise eyelids, pupil constriction, lens shape)
4
Q
CN IV
A
Trochlear (inward and downward movement of the eye)
5
Q
CN V
A
Trigeminal (Muscles of mastication, sensation of the face and scalp, cornea, mucous membranes of mouth and nose)
6
Q
CN VI
A
Abducens (lateral movement of the eye)
7
Q
CN VII
A
Facial (facial muscles, close eyes, speech, taste, saliva and tear excretion)
8
Q
CN VIII
A
Acoustic (hearing)
9
Q
CN IX
A
Glossopharyngeal (phonation and swallowing, taste, gag reflex)
10
Q
CN X
A
Vagus ( talking/swallowing, carotid reflex, pharynx)
11
Q
CN XI
A
Spinal (movement of trapezius and sternomastoid muscles)
12
Q
CN XII
A
Hypiglossal (movement of the tongue)
13
Q
Causes of seizres
A
Cerebrovascular disease Hypoxemia of any cause Fever (childhood) HTN CNS infections Metabolic/toxic condition Drug/alcohol withdrawal Allergies
14
Q
Characteristics of Grand Mal seizure (tonic clonic)
A
Last about 2 minutes
Aura occurs
Muscle contraction, periods of apnea (tonic)
Excessive salivation, forceful movement of extremities, rapid pulse (clonic)
Possible incontinence
Stupor 5-10 min following clonic phase
15
Q
Characteristics of Petit Mal seizure (Absent seizure)
A
Small movement of face or eyes Staring into space Last for few seconds to a min Occur mostly in children Dulling of consciousness Usually no falling
16
Q
Characteristics of Jacksonian seizure
A
Begins with one part of the body (twitching of one side of face of abnormal movement of one hand)
17
Q
Characteristics of complex seizure
A
Pt exhibits altered behaviors, unusual sensation (not aware of it)
18
Q
Nursing care during a seizure
A
- Provide privacy
- Aura occurs?
- Ease pt to floor
- Push aside furniture
- Loosen constrictive clothing
- Remove pillows/raise side rails
- Note where in the body the seizure began
- Any incontinence?
- Duration of seizure?
- Don’t attempt to pry open jaws
- Do not restrain pt
- Place pt on one side
19
Q
Nursing care after a seizure
A
- Keep pt on side to prevent aspiration
- Pt should be reoriented
- Document event leading to and occurring before/after
- Maintain airway
20
Q
What is status elipticus?
A
A series of generalized seizures that occur w/o full recovery of consciousness b/w attacks
21
Q
Medical management of status elilepticus
A
- Stop the seizure as quickly as possible
- Airway and adequate O2
- IV Valium, Cerebryx given slowly
- Blood samples
- EEG
- Neuro checks
22
Q
Division of the Peripheral nervous system
A
Autonomic (involuntary efferent)
Somatic (stimulates voluntary muscles)
23
Q
Division of autonomic system
A
Parasympathetic (Rest and digest)
Sympathetic (Fight or flight)
24
Q
Functions of the frontal lobe
A
Voluntary movement Personality/Mood initiative/judgement Planning Social behavior Bladder control Concentration Broca's area (motor control of speech)
25
Functions of the parietal lobe
```
Attention to stimuli
Dressing
Drawing
Feeling shape and texture
Spatial imaging
Finding one's way around
```
26
Functions of occipital lobe
Interpreting vision
27
Functions of temporal lobe
```
Visual memory
Facial recognition
Music appreciation
Hearing
Mood (aggression)
Non-language
```
28
Dizziness
A sensation of imbalance or movement. Can be caused by viral syndromes, hot weather, roller coaster rides, and middle ear infections
29
Vertigo
The illusion of movement
30
Normal range of ICP
10-20mm Hg
31
Patho of increased ICP
Cerebral bl flow decreases, which results in ischemia and cell death. A sympathetic response is activated which causes a subsequent increase in BP. The increased BP then activates the parasympathetic system via carotid artery baroreceptors resulting in a vagal induced bradycardia. (Cushings reflex)
32
Signs of increased ICP (Cushings triad)
Increase in BP
Bradycardia
Bradypnea
33
Difference between shock and Cushing's triad
In shock there is a decrease in BP, and increase in respirations and pulse
34
Manifestations of worsening ICP
```
Changes in LOC
Restlessness w/o cause
Confusion, increasing drowsiness
Pt may only react to only loud or painful stimuli
Decorticate or decerebrate
```
35
Patho of migraines
Often hereditary, associated w/ low Mg levels in brain
Attacks can be triggered by hormonal changes associated with menstrual cycle, bright lights, stress, depression, sleep deprivation, fatigue and odors. Foods containing tyramine (aged cheese), nitrates or milk products may trigger attack.
36
What occurs in the aura phase of a migraine?
Lasts less than 1 hr, enough time for pt to take medication, Visual disturbances may occur, and may be hemianopic. Numbness and tingling of the lips, face or hands, mild confusion, sllight weakness of an extremity, drowsiness and dizziness may occur.
37
What are the 5 categories of a neuro assessment?
```
Consciousness and cognition
Cranial nerves
Motor system (muscle tone, atrophy)
Sensory system (sensation, pain?)
Reflexes
```
38
3 parts of the Glasgow coma scale
Eye movement
Verbal response
Motor response
39
A 3 in the glasgow coma scale section of motor response indicates what type of positioning?
Decorticate
40
A 2 in the glasgow coma scale section of motor response indicates what type of positioning?
Decerebrate
41
Characteristics of left hemispheric stroke
Slow cautious behavior
Aphasia (expressive, receptive or global)
Altered intellectual ability
Right visual field deficit
Paralysis or weakness on the right side of the body
42
Characteristics of right hemispheric stroke
Lack of awareness of deficits
Left visual field deficit
Impulsive behavior
Increased distractibility
Paralysis or weakness on the left side of the body
Spatial-perceptual deficit; trouble learning to care for themselves
43
Criteria for t-PA
- 18years old<
- Clinical dx of ischemic stroke
- Systolic <15sec
- Not received heparin during last 48hrs
- No prior intracranial bleed, AVM, neoplasm or procedure
- No major surgical procedures within days
- No stroke, serious head injury, or intracranial surgery within the last 3 months
- No GI or urinary bleeding within days
44
Characteristics of Type 1 diabetes
```
Body does not make insulin
Autoimmune response
Normal weight
Glucose remains in the bl stream
Production of ketones
```
45
Characteristics of of type 2 diabetes
Insulin resistance (insulin is not as effective)
Impaired insulin secretion
Obesity
More common in adults
46
S/S of hyperglycemia (hot and dry, blood sugar high)
```
Extreme thirst
Frequent urination
Dry skin
Hunger
Blurred vision
Drowsiness
Decreased healing
```
47
Causes of hyperglycemia
```
Too much food
Too little insulin
Illness
Stress
Gradual onset
```
48
S/S of hypoglycemia (cold and clammy, need some candy)
```
Shaking
Tachycardia
Sweating
Dizziness
Anxiety
Hunger
Impaired vision
Weakness/fatigue
HA
Irritability
```
49
Yearly screenings for pts with diabetes
-Cholesterol check annually
-Dental exam 2x a year
-Foot check w/ Dr every visit
-Thorough foot exam annually
-Urine check for kidney damage (microalbumin) annually
Pneumonia vaccine and flu shot annually
-Dilated eye exam with ophthalmologist annually
50
Foot care for a pt with diabetes
```
Look for cuts, blisters, red spots, and swelling.
Wash feet everyday in warm water
Dry well, b/w toes
Keep feet smooth and soft
Trim toenails weekly
Avoid contact with hot surfaces
Elevate feet when sitting, avoid crossing legs
Never walk barefoot
```
51
How is diabetes diagnosed
Hx of the 3 P's
Fasting bl glucose < twice
GTT
A1C higher than 7%
52
Educating pt on insulin
```
Refrigerate
Do not freeze or keep in heat
Keep at room temp once opened
Never inject cloudy into clear
Do not use exact same site
Insulin should not be injected into limb that will be exercised
```
53
Diabetic ketoacidosis is caused by
An absence or inadequate amount of insulin resulting in disorders in the metabolism of carbs, proteins, and fats
54
Main sx of DKA
```
hyperglycemia
Dehydration and electrolyte loss
Acidosis
Acetone breath
Polyuria
Polydipsia
Fatigue
Blurred vision
Weakness
HA
```
55
Patho of DKA
W/o insulin, the amount of glucose entering the cells is reduced. The release of glucose by the liver is increased causing hyperglycemia. To rid the body of excess glucose the kidneys excrete it with water and electrolytes. Polyuria leads to dehydration. Free fatty acids are converted into ketone bodies by the liver.
56
What is hyperglycemic hyperosmolar syndrome?
Metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin
57
Difference b/w DKA and HHS
In DKA there is no insulin present. In HHS insulin is too low to prevent hyperglycemia but high enough to prevent fat breakdown. Acidosis doesn't occur in HHS
58
Sx of HHS
```
Hypotension
Profound dehydration
Tachycardia
Altered LOC
Seizures
```
59
Stroke volume
Amount of blood ejected with each heartbeat
60
Cardiac output
Amount of blood pumped by ventricle in liters per minute
61
Preload
Degree of stretch of cardiac muscle fibers at the end of diastole
62
Contractility
Ability of cardiac muscle to shorten in response to electrical impulse
63
Afterload
Resistance to ejection of blood from ventricle
64
Ejection fraction
Percent of end diastolic volume ejected with each heart beat
65
Sx of left sided heart failure
```
Crackles
Dyspnea
Dry cough
Orthopnea
Diminished CO
Oliguria
```
66
Sx of right sided heart failure
```
JVD
Edema of lower extremities
Hepatomegaly
Ascites
Generalized weakness
```
67
Stable angina
Predictable and consistent pain that occurs on exertion and is relieved by rest of NTG
68
Unstable angina (Preinfaction angina)
Sx increase in frequency and severity, may not be relieved by rest or NTG
69
Intractable (refractory) angina
Severe incapacitating chest pain
70
Variant angina
pain at rest with reversible ST segment elevation
71
Silent ischemia
Objective evidence of ischemia but pt reports no pain
72
What is Raynuads phenomenon?
A form of intermittent arteriolar vasoconstriction that results in the coldness, pain and pallor of the fingertips or toes. Most common in women
73
Sx of DVT
Edema and swelling of the extremity b/c of the outflow of venous blood is inhibited. The affected extremity may be warmer, tenderness
74
What medication should be given to increase contractility in patients with heart failure?
Digoxin
75
To decrease afterload, what meds should be given?
Vasodialator
Nitroglycerin
Ca+ channel blockers
Beta blockers
76
ST segment is depressed with
Ischemia
77
ST segment is elevated with
MI, cardiac injury
78
What is primary HTN?
High BP from an unidentified cause, most common
79
What is hypertensive emergency?
BP is extremely elevated and must be lowered immediately to prevent damage to target organs. Goal is to reduce pressure by 20-25% within the first hour
80
What is hypertensive urgency?
BP is very elevated but there is no evidence of impending or progressive target organ damage.. Associated with severe headaches, nosebleeds, or anxiety. ACE inhibitors and beta blockers are used to treat.
81
What is metabolic syndrome?
A cluster of conditions that occur together, increasing your risk of heart disease, stroke and diabetes.
82
EKG changes that occur with an MI
T wave inversion
ST elevation
Abnormal Q-wave
83
STEMI
Patient has ekg with evidence of acute MI with characteristic changes in two contiguous leads on a 12 lead. In this type of MI, there is significant damage to the myocardium
84
NSTEMI
The pt has elevated cardiac biomarkers but no definite EKG evidence of acute MI. In this type of MI there may be less damage to the myocardium.
85
Characteristics of arterial circulatory insufficiency
```
Diminished/absent pulses
Cool/cold skin
Loss of hair over toes
Dry shiny skin
Deep, circular ulcer
Minimal leg edema
Very painful
Intermittent claudication
```
86
Characteristics of venous insufficiency
```
Present but difficult to palpate pulses thru edema
Skin thickened
Reddish blue skin
Minimal pain
Irregular border ulcer
Moderate to severe leg edema
Aching and cramping
```
87
What is Buergers disease?
Rare disease characterized by the obstruction of blood vessels in the hands and feet, reducing the availability of blood to the tissues causing pain and eventually damages the tissue
88
Sx of Beurgers disease
```
Pain/tenderness
Numbness and tingling in limb
Skin ulcer or gangrene of the digits
Discoloration
Pain may increase w/ activity
Pulse may be decreased in affected extremity
```
89
Sulfonylureas
| Glyburide, Glipizide
Tell the pancreas to make more insulin
90
Metformin
Tells the liver to stop sending out sugar
91
Glitazones
| Avandia and Actos
Help insulin in the body work better
92
Meglitinides
| Prandin, Starlix
Tell the pancreas to make more insulin. Taken with meals
93
Alpha-glucosidase inhibitors
| Precose, Glyset
Slow down the absorption of cabs from the intestines after you eat
94
Droplet Precautions
Ex: Meningitis, pneumonia, influenza, mumps, rubella
Mask and private room
Doors may remain open
95
Airborne precautions
Ex: TB, measles, chickenpox
Private negative pressure room
Keep doors closed
96
Contact precautions
Most frequent mode of transmission
Ex: Hep A, herpes, C.Diff
Gloves, gown, private room in addition to standard precautions
97
What is Dumping syndrome?
Response to rapid emptying of gastric contents into the small intestine
98
Sx of dumping syndrome?
```
Fullness
Weakness
Faintness
Dizziness
Palpitations
Cramping pain
Nausea
Sweating
Diarrhea
```
99
Melena
Tarry or black stools: indicative of occult blood in stools
100
Psoas sign
Right hand above right knee, raise leg against resistance, flexion of hip causes contraction of psoas muscle. appendicitis?
101
Chain of infection
```
Infectious agent
Resevoir
Portal of exit
mode of transmission
Portal of entry
Susceptible host
```
102
Blumberg's sign
Abdominal wall is compressed slowly and then rapidly released. Indicative of peritonitis
103
Rovsing's sign
Pain in RLQ during pressure in LLQ. Sign of appendicitis, or peritoneal irritation
104
Murphy's sign
Palpate liver while pt take in deep breath. Sharp pain with no inhalation
Possible cholecystitis
105
What is gastritis?
Inflammation of the gastric stomach mucosa
106
S/S of acute gastritis
```
Abdominal discomfort
HA
N/V
Lassitude
Hiccuping
```
107
S/S of chronic gastritis
```
Melena
Blood in vomit
Anorexia
Heartburn after eating
Belching
Sour taste in mouth
N/V
Malabsorption on B12
```
108
Malabsorption of B12 leads to
Pernicious anemia
109
What is Peptic ulcer disease
An excavation that forms in the mucosal wall of the stomach, pylorus, duodenum, or the esophagus
110
Patho of PUD
Erosion is caused by the increased concentration of acid-pepsin or by decreased resistance of the mucosa. A damaged mucosa cannot secrete enough mucus to act as a barrier against HCl
111
S/S of duodenal PUD
```
Pain is relieved by food
Melena
Pain commonly occurs 2-3hrs after meals
Awake with pain during the night
No weight loss
```
112
S/S of gastric PUD
Food does not relieve pain
Pain occurs immediately after eating
Hematemesis
113
Medication used to treat ulcers from H.pylori
Antibiotic (Flagyl, amoxicillin)
Proton pump inhibitor (-prazole)
Bismuth salts (pepto bismol)
114
Medication used to treat non h.pylori ulcers
H2 receptor antagonist (Pepcid, Zantac)
| PPI (-prazole)
115
What do Proton pump inhibitors do?
Decrease gastric secretion by slowing the pump on the parietal cells
116
What do H2 receptor antagonists do?
Decrease the amount of HCl produced by the stomach by blocking action of histamine on histamine receptor of parietal cells in the stomach
117
What is Crohn's disease?
A subacute and chronic inflammation of the GI tract wall that extends thru all layers, most commonly occurs in the distal ileum
118
S/S of Crohns disease
```
RLQ pain
Diarrhea
Abdominal tenderness/spasm
Cramping occurs after meals
Weight loss
Malnutrition
anorexia
N/V
Anemia
Dehydration
```
119
What is ulcerative colitis?
Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
120
S/S of ulcerative colitis
```
LLQ pain
Passage of mucus and pus
Diarrhea (10-20 liquid stools)
Rectal bleeding
Weight loss
Anorexia
Anemia
Fever
Vomiting
Dehydration
```
